Contract Details
Ancillary Care Services
Facility name
Gateway Home Medical
Provider ID
P000005472
NPI
1851392088
Tax ID
202052802
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
200 Centre Drive Suite 3
Burleson, TX 76028
United States
County
Johnson
Phone
8178200505 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address